scholarly journals Results of on-pump and off-pump coronary artery bypass graft surgery in 30 days: an analysis by propensity score matching

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Rosler ◽  
G Constantin ◽  
P Nectoux ◽  
B S Holz ◽  
D Cardoso ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Logistic Regression Model ◽  
Independent Predictor ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Cabg

Abstract Background The results of coronary artery bypass graft surgery (CABG) performed with and without the support of cardiopulmonary bypass have already been widely discussed and studied, including through a few large randomized clinical trials. Despite the efforts, the findings of these studies still generate controversy and doubts about the outcomes achieved by the two techniques. One of the contested points is the heterogeneity of the degree of specialization in the off-pump technique in relation to the surgical groups that participated in the studies. Purpose To compare the results in 30 days of on-pump and off-pump CABG. Methods A single centre cohort with 1,767 patients undergoing isolated CABG was initially evaluated (January 2013 – December 2018). 397 patients undergoing off-pump CABG and 1,370 patients undergoing on-pump surgery were identified. To obtain two completely homogeneous study groups, a propensity score matching was applied. For this, a logistic regression model was built with the variable use of CPB support as dependent variable. In the group of independent variables, 14 baseline and operative characteristics were included. The probabilities generated for each patient were used as scores to establish the match. To establish a pair, it was necessary to have three squares after the comma, with the fourth decimal place being the tiebreaker criterion in the pairing. In this way it was possible to obtain 332 pairs (N=664). The paired groups, on and off-pump, were compared by descriptive and univariate analysis and later a logistic regression model was applied to identify possible risk predictors and to verify the impact of CPB support on 30-day mortality. The level of significance was 5% and the analysis was performed using Python 3.0. Results None of the 29 baseline and operative characteristics showed a significant difference between the groups, demonstrating a high degree of homogeneity obtained from the propensity score matching, which enabled a solid comparison between the incidences of outcomes in 30 days. None of the analysed outcomes showed any difference between the groups on and off-pump, including AMI, stroke, major reoperation and death (1.5% vs 2.4%; p=0.401). Through regression analysis it was possible to establish that the use of CPB was not an independent predictor of risk for the occurrence of death (p=0.246). Conclusion After matching by propensity score, patients who underwent surgery with and without CPB had similar incidences of 30-day mortality. In addition, it was possible to verify that the use of CPB was not an independent predictor of risk for the occurrence of death in 30 days. FUNDunding Acknowledgement Type of funding sources: None. Propensity score adjustment by group 30-day outcomes vs CABG technique

scholarly journals Evaluation Of Pulmonary Functions Of Off-Pump Coronary Artery Bypass Graft Patients

KYAMC Journal ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 341-347
Author(s):  
Md Masumul Gani Chowdhury ◽  
Md Zakaria ◽  
NAK Ahsan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Gas Exchange ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pulmonary Functions ◽  
Significant Difference ◽  
Pump Cabg

Background: Cardiopulmonary bypass has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass graft (CABG). This nonrandomized prospective study was conducted to determine whether patients undergoing off-pump CABG and thereby avoiding cardiopulmonary bypass will have improved pulmonary functions postoperatively.Method: Sixty patients undergoing elective CABG in the National Institute of Cardiovascular Diseases (NICVD), Dhaka between July 2005 and June 2006 were consecutively selected in the study. Sample was divided into two groups: Group A- off-pump CABG and Group-B on-pump CABG. The test statistics used to analyze the data were descriptive statistics as Chi-square (×2) and Student's t-test.Results: Preoperative arterial blood gas (ABG) analysis showed no significant difference. ABG immediately at ICU on FiO2 1 revealed significantly better gas exchange in off-pump group (PaO2: 296.5±32.4 torr vs 234.8±10.7 torr, p<0.001; D(A-a)O2: 378.5±27.3 torr vs 439.2±10.3 torr, p<0.001; PaCO2: 38.5±3.8 torr vs 40.1±1.8 torr, p=0.045). ABG on 3rd postoperative day revealed no significant difference between the two groups. Ventilation time in off-pump group was significantly less than in on-pump group (10.5±2.8 hours vs 14.8±3.7 hours, p<0.001). For ICU stay, there was no significant difference. Postoperative spirometry at 3 month and pulmonary complications within 3 months were not different between groups.Conclusion: off-pump CABG group yielded better gas exchange and earlier extubation than on-pump CABG group.KYAMC Journal Vol. 4, No.-1, July 2013, Page 341-347

scholarly journals On-Pump Beating Heart versus Off-Pump Coronary Artery Bypass Graft Surgery: Short-Term Follow-up Outcomes of a Single Center

2021 ◽  
Vol 7 (1) ◽  
pp. 3-8
Author(s):  
Ekin İlkeli ◽  
Ali Cemal Düzgün
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Artery Bypass Graft ◽  
Single Center ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg

Abstract Background and Aim: Novel surgical approaches are gaining attention in an attempt to overcome possible adverse events following coronary artery bypass graft (CABG) surgery. This single-center study aimed to evaluate and compare the early postoperative outcomes of on-pump beating-heart (OPBH-CABG) versus off-pump CABG surgery in similar risk groups with a total number of 1–2 grafts. Methods: The records of a total of 229 patients who underwent non-emergency, primary, isolated, either OPBH-CABG (n = 32) or off-pump CABG (n = 197) surgery were retrospectively evaluated. Reported outcome measures included baseline data, the number of coronary artery grafts, prophylactic intra-aortic balloon pump, time of extubation from mechanical ventilation, duration of stay in the coronary ICU and hospital, as well as early postoperative complications, in-hospital and early postoperative mortality. Results: The groups were identical with regards to age and BMI. The patients in the off-pump group received a higher number of grafts (1.84 ± 0.36 vs. 1.18 ± 0.39, p <0.0001). The OPBH-CABG group had a higher Euroscore II score (2.514 ± 1.68 vs. 1.706 ± 1.93, p = 0.021). The time to extubation after the surgery, postoperative length of ICU stay, and total length of hospital stay were similar between the groups (p = 0.2228; p = 0.098; p = 0.717, respectively). The incidence of arrythmia and atrial fibrillation was higher in the on-pump group (12.5% vs. 2.53%, p <0.05). One patient in the on-pump, and four patients in the off-pump groups deceased due to postoperative complications. Conclusions: OPBH-CABG surgery is comparable to off-pump CABG in terms of early postoperative outcomes. In patients who underwent OPBH-CABG, the risk of arrythmia and atrial fibrillation should be of concern and solved with optimal strategies.

scholarly journals Predictors of atrial fibrillation after off pump coronary artery bypass graft-a prospective observational study

2021 ◽  
Author(s):  
Nidheesh Chooriyil ◽  
Manjusha N. Pillai ◽  
Thanath K. N. Jayakumar
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Prospective Observational Study ◽  
Independent Predictor ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Atrial Size ◽  
Low Ejection Fraction

Background: Postoperative atrial fibrillation (AF) is a common and potentially morbid complication following coronary artery bypass graft (CABG) surgery. Many factors have been suggested to increase the incidence of post-operative AF after CABG. Objective was to estimate the proportion of patients developing AF after off pump CABG (OPCABG) and to determine the possible predictors of AF after OPCABG.Methods: This was a prospective observational study done in the department of Cardiovascular and Thoracic Surgery of a tertiary center from December 2019 to December 2020 after obtaining Institutional review board clearance.  A sample size of 334 was fixed and patients undergoing OPCABG were consecutively recruited in the study. The association of preoperative and postoperative factors with occurrence of AF were analysed using the univariate analysis with a p value <0.05 using the SPSS 16 software. Multivariate analysis was done to determine the independent predictors after OPCABG.Results: In this prospective study amongst the 334 patients recruited 60 (18%) developed atrial fibrillation and the maximum incidence was seen on the third postoperative day. Patients who developed AF were older with mean age of 61.38±7.63 years, 2.96 (95% CI 0.71-5.21) as compared to those who did not develop AF. Male gender Odds ratio 1.17 (95%CI 1.06-1.31), low ejection fraction 54.95±10.47, -3.25 (95% CI-5.99- -0.52); large atrial size 3.45±0.42, 0.12 (95% CI 0.02-0.06); long intensive care unit (ICU) stay 2.47±0.59, 0.32 (95% CI 0.06-0.21) and long hospital stay 7.62±3.36, 1.48 (95% CI 0.44-0.59) were associated with development of AF after OPCABG. Older age was found to be an independent predictor of development of AF on doing multivariate analysis.Conclusions: In our study advanced age was found to be an independent predictor of atrial fibrillation after OPCABG. Males, low ejection fraction, large atrial size and longer ICU and hospital stays were associated with occurrence of AF after OPCABG.

scholarly journals The Effect of Classic Chest Physiotherapy on Postoperative Pain Scores and Hospital Stay in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

2018 ◽  
Vol 7 ◽  
pp. e838
Author(s):  
Mohammad Zolfaghari ◽  
ُSeyed Jalil Mirhosseini ◽  
Maryam Baghbeheshti ◽  
Brent A. Bauer
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Chest Physiotherapy ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Background: Chest physiotherapy (CPT) is a care that increases the mobilization of several structures from both muscle and subcutaneous tissue. We planned to investigate the effect of classic CPT on pain, fatigue, satisfaction, and hospital length of stay (LOS) in patients undergoing off-pump coronary artery bypass graft (CABG). Materials and Methods: This study was a randomized controlled trial that conducted on 50 patients undergoing elective off-pump CABG. The patients have been randomly divided into two groups; in the group A (n=25) patients received physiotherapy at a single session of classic CPT, 4 times during 2nd to 5th days for 15 minutes in every session, in the group B (n=25) patients had not protocol of this exercise therapy (control). Results:The average age of all participants was 62.08 ±9.08 years. Of the 50 patients, 33 (66%) was male. Classic CPT significantly decreased pain (P=0.04), hospital LOS (P=0.010) and could increase in patients’ satisfaction (P<0.001). However, it had no considerable effect on fatigue (P=0.725). Conclusion: According to our findings, classic CPT could improve postoperative care after off-pump CABG surgery. [GMJ.2018;7:e838]

scholarly journals Heart Rate Variability after Off-Pump versus On-Pump Coronary Artery Bypass Graft Surgery

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Nenad Lakusic ◽  
Valentina Slivnjak ◽  
Franjo Baborski ◽  
Dusko Cerovec
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Cabg ◽  
Cabg Patients

Background.It is known that after coronary artery bypass graft surgery (CABG) heart rate variability (HRV) becomes significantly decreased with a gradual recovery in a few months after surgery. However, literature data about the impact of the off-pump CABG on postoperative HRV are not complete. Therefore, the aim of this study was to analyze postoperative value of HRV in CABG patients operated on with off-pump versus on-pump coronary surgery.Methods.This study included 206 consecutive patients who underwent CABG. Sixty six patients (32%) were operated on off-pump while 140 patients (68%) were operated on using the machine for extracorporal circulation. HRV was analyzed from 24-hours Holter electrocardiogram recordings.Results.No significant differences in postoperative values of HRV variables were found between off-pump versus on-pump CABG patients (Mean RR interval 885 106 versus 879 125 ms, standard deviation of all normal R-R intervals 107 30 versus 105 34 ms, NS, total power 2298 2472 versus 2156 1913 ms2, NS).Conclusions.The results of the study showed that there are no differences in HRV few months after surgery between patients operated on with off-pump versus on-pump CABG.

Abstract 3046: Protective Effect Of Preoperative Angiotensin Converting Enzyme Inhibitors On Renal Outcome Following Coronary Artery Bypass Graft Surgery. A Propensity Score-adjusted Analysis

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Umberto Benedetto ◽  
Simone Refice ◽  
Antonino Roscitano ◽  
Fabio Capuano ◽  
Caterina Simon ◽  
...  
Keyword(s):  
Propensity Score ◽  
Ace Inhibitors ◽  
Adverse Outcome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Renal Outcome ◽  
Artery Bypass Graft ◽  
Converting Enzyme ◽  
Cabg Surgery ◽  
Pump Cabg

Introduction: A large number of patients undergoing coronary artery bypass graft (CABG) surgery are treated with angiotensin converting enzyme (ACE) inhibitors before the operation. Since ACE inhibitors decrease glomerular perfusion pressure, it is still believed that their withdrawal before surgery on cardiopulmonary bypass may reduce postoperative renal adverse events. However, no previous study has attempted to address this issue. We aimed to evaluate the impact of preoperative ACE inhibitors on renal outcome in patients undergoing on pump CABG surgery using a risk adjusted approach. Methods and Results: A propensity score-based analysis of 531 patients undergoing elective isolated CABG surgery on cardiopulmonary bypass. Patients with preoperative end-stage renal failure requiring dialysis were excluded. Of those 531 patients, 204 were treated with ACE inhibitors before the operation and 327 were not treated with ACE inhibitors. Renal adverse outcome following surgery was defined as 20% decrease in creatinine clearance from preoperative or post-operative mechanical renal support. After adjusting for propensity score and covariates, multivariate analysis showed that preoperative ACE inhibitors had a protective effect against renal adverse outcome following CABG surgery (odds ratio [OR], 0.8; 95% confidence interval [CI],0.5 to 0.9; P <0.01). Other independent predictors of adverse renal outcome were age (OR 1.17 per 1 years; 95% CI 1.01 to 1.39; P <0.001), female sex (OR 0.72; 95% CI 0.51 to 0.93; P <0.001); left ventricular ejection fraction less than 0.30 (OR 2.12; 95% CI 1.92 to 2.85; P <0.01); pre-operative creatinine clearance (OR 1.23 per 10ml/min decrease; 95% CI 1.01 to 1.31; P <0.001); diabetes (OR 1.80; 95% CI 1.25 to 2.24; P <0.01); aortic cross clamp time (OR 1.31 per 10 min increase; 95% CI 1.11 to 1.61; P <0.01). Operative mortality was not statistically different between groups (2.4% versus 4.0% in patients with and without preoperative ACE inhibitors; P =0.45) Conclusions: Preoperative ACE inhibitors are associated with better renal outcome in patients undergoing on pump CABG surgery. No clinical evidences support ACE inhibitors withdrawal before surgery

scholarly journals EuroScore II is the best predictive model for the off pump coronary artery bypass graft surgery

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Rosler ◽  
P Nectoux ◽  
G Constantin ◽  
B S Holz ◽  
D Cardoso ◽  
...  
Keyword(s):  
Predictive Accuracy ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Other ◽  
Risk Scores ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Sts Score ◽  
Pump Cabg ◽  
Death Group

Abstract Background Coronary artery bypass graft surgery (CABG) is the most common cardiac surgery performed in the world and a significant part of these surgeries are performed without cardiopulmonary bypass (off pump). Although none of the main surgical risk scores include pump use in their prediction model, the scores are widely used in risk stratification, including for patients who will be submitted to off pump CABG. Purpose To analyse and compare the predictive accuracy of EuroScore I, EuroScore II and STS Score for 30-day mortality after off pump CABG. Methods Single-centre cohort with 943 patients consecutively submitted to off pump CABG between January 2010 and December 2020. 31 baseline and operative variables were analysed. The primary outcome was the occurrence of death in the first 30 days after the surgery. Descriptive analysis, normality for quantitative data and univariate inference were performed to compare proportions and means between the survival group (n=930) and death group (n=13). Next, three logistic regression models were performed. Each of them had 30-day mortality as a dependent variable and one of the scores as an independent variable. The probabilities generated by the three models were saved and analysed by ROC curves. Thus, it was possible to assess the predictive accuracy of each of the scores. Finally, the values of the areas under the curves were compared using the DeLong test. The level of significance was 5% and the analysis was performed using the Python 3.0 programming language. Results The mean age of the general group was 63 years old and there was a predominance of male patients (68.4%). The means of the three evaluated risk scores were significantly higher in the Death group (p&lt;0,05). This pattern confirmed the findings of higher prevalence of several comorbidities in the death group. The 30-day mortality rate was 1.37%. Through the analysis of regressions and the probabilities generated through them, it was possible to verify that the predictive accuracy of EuroScore II was significantly higher than that of the other two scores. While the predictive accuracy of EuroScore II was 77.3%, the accuracy of two other scores was in the range of 69% (AUC EsI: 0.697; AUC EsII: 0.773; AUC STS: 0.695; p=0.029). Conclusion EuroScore II seems to be the most adequate surgical risk score for the assessment of mortality risk of patients who will undergoing to off pump CABG. The score had a predictive accuracy of 77.3%, almost 8% more than the other two scores. Therefore, although EuroScore II does not include in its model the use of cardiopulmonary bypass, it has a satisfactory accuracy to be used in clinical-surgical practice. On the other hand, the EuroScore I and the STS Score showed predictive accuracy not adequate for this type of surgery. FUNDunding Acknowledgement Type of funding sources: None. Predictive accuracies of risk scores

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